Provider Demographics
NPI:1104144575
Name:HAMILTON, KIMBERLY ELISE (LSW)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ELISE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ELISE
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:336 W PASSAIC ST
Mailing Address - Street 2:2ND FL
Mailing Address - City:ROCHELLE PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07662-3027
Mailing Address - Country:US
Mailing Address - Phone:201-845-7030
Mailing Address - Fax:201-845-0899
Practice Address - Street 1:336 W PASSAIC ST
Practice Address - Street 2:2ND FL
Practice Address - City:ROCHELLE PARK
Practice Address - State:NJ
Practice Address - Zip Code:07662-3027
Practice Address - Country:US
Practice Address - Phone:201-845-7030
Practice Address - Fax:201-845-0899
Is Sole Proprietor?:No
Enumeration Date:2010-05-11
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05561600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ44SL05561600OtherSTATE OF NJ DIVISION OF CONSUMER AFFAIRS/BOARD OF SOCIAL WORK EXAMINERS